Micaela Rae Shannon

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN11015772 Issued in FL

Practice address

7016 Normandy Blvd
Jacksonville, FL 32205-6206

Phone

(904) 783-2405

Fax

(904) 420-6101

NPI assigned

Nov 19, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Micaela Rae Campbell Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ed Fraser Memorial Hospital Hospital, Macclenny, FL, CCN 100134
• Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
• Brooks Rehabilitation Hospital University Campus Inpatient rehabilitation facility, Jacksonville, FL, CCN 103039

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: micaela.shannon.1@4290.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Millennium Physician Group LLC

  • Family Medicine Physician
  • Fort Myers, FL
  • NPI 1811122880
  Medicare reassignment Care Compare group NPD
• Millennium Physician Group LLC

  • Family Medicine Physician
  • Brooksville, FL
  • NPI 1073131702
  NPD
• Family Care Partners Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Jacksonville, FL
  • NPI 1386147882
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baker County Medical Services Inc

  • Rural Acute Care Hospital
  • Macclenny, FL
  • NPI 1104926401
  Care Compare affiliation
• Genesis Rehabilitation Hospital, Inc.

  • Rehabilitation Hospital
  • Jacksonville, FL
  • NPI 1376114413

  Inpatient rehabilitation facility

  Care Compare affiliation
• Genesis Rehabilitation Hospital, Inc.

  • Rehabilitation Hospital
  • Jacksonville, FL
  • NPI 1912947748

  Inpatient rehabilitation facility

  Care Compare affiliation
• Southern Baptist Hospital of Florida Inc

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1578620449
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1023654647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7016 NORMANDY BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322056206",
            "telephone_number": "904-783-2405",
            "fax_number": "904-420-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "MICAELA",
        "middle_name": "RAE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-19",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "APRN11015772",
            "primary": false
        },
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "FL",
            "license": "RN9469517",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11015772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICAELA",
            "last_name": "CAMPBELL",
            "middle_name": "RAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Andrew White Shannon, M.D., M.P.H.
• Daphne Sainvil Shannon, LCSW
• Kristin D Shannon
• Lauren Desmond Shannon, ARNP
• Matthew Brian Shannon, MD
• Rachel Shannon
• Robert Shannon, MD
• Storm W Shannon, D.C., A.T.C.
• Ammar Shano
• Van Shantharam, M.D.

• Family Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.